Hip Fracture

What is a hip fracture?

A hip fracture is a break in the thigh bone (femur) of your hip joint.

Joints are areas where two or more bones meet. Your hip joint is a "ball and socket"
joint, where your thigh bone meets your pelvic bone. The ball part of your hip joint
is the head of the thigh bone. The socket is a cup-like structure in your pelvic bone.
This is called the acetabulum. Hip fracture is a serious injury and needs immediate
medical attention.

The majority of hip fractures happen to people older than age 60. The incidence of
hip fractures increases with age, doubling for each decade after age 50. Caucasians and Asians
are more likely to be affected than others. This is primarily because of a higher
rate of osteoporosis. Osteoporosis (loss of bone tissue) is a disease that weakens
bones.

Women are more prone to osteoporosis than men; therefore, hip fracture is more common
among women. They experience most hip fractures. More than 1.5 million Americans have
fractures annually because of osteoporosis.

Either a single break or multiple breaks can happen in a bone. A hip fracture is classified
by the specific area of the break and the type of break(s) in your bone.

The most common types of hip fractures are:

Femoral neck fracture. A femoral neck fracture happens 1 to 2 inches from your hip joint. This type of fracture
is common among older adults and can be related to osteoporosis. This type of fracture
may cause a complication, because the break usually cuts off the blood supply to the
head of the thigh bone, which forms the hip joint.

Intertrochanteric hip fracture. An intertrochanteric hip fracture happens 3 to 4 inches from your hip joint. This
type of fracture does not usually interrupt the blood supply to your bone and may
be easier to repair.

The majority of hip fractures fall into these 2 categories in relatively equal numbers.
Another type of fracture, called a stress fracture of the hip, may be harder to diagnose.
This is a hairline crack in the thigh bone that may not involve your whole bone. Overuse
and repetitive motion can cause a stress fracture. The symptoms of this injury may
mimic those of tendonitis or muscle strain.

What causes a hip fracture?

A fall is the most common reason for a hip fracture among the elderly. A small percentage
of people may have a hip fracture happen spontaneously. If you are younger, a hip
fracture is generally the result of a car accident, a fall from a great height, or
severe trauma.

Hip fracture is more common in older people. This is because bones become thinner
and weaker from calcium loss as a person ages. This is generally due to osteoporosis.

Bones affected by osteoporosis are more likely to break if you fall. Most hip fractures
that older people get happen as a result of falling while walking on a level surface,
often at home.

If you are woman, you lose 30% to 50% of your bone density as you age. The loss of
bone speeds up dramatically after menopause, because you produce less estrogen. Estrogen
contributes to maintaining bone density and strength.

What are the risk factors for hip fracture?

A risk factor is anything that may increase your chance of developing a disease. It
may be an activity, diet, family history, or many other things. Different diseases
have different risk factors. Although these factors can increase your risk, they do
not necessarily cause the disease. For example, you may have one or more risk factors
for a certain disease or condition, but never develop it. On the other hand, you may
not have any known risk factors, but develop the disease or condition anyway.

Being aware of your risk factors for any disease can help you take appropriate actions,
such as changing behaviors and being clinically monitored for the disease.

Osteoporosis is the leading cause of hip fracture. Age is also a major risk factor.
Other possible risk factors for hip fracture may include the following:

Excessive alcohol consumption

Lack of physical activity

Low body weight

Tall stature

Vision problems

Dementia

Medicines that cause bone loss

Cigarette smoking

Institutional living, such as an assisted-care facility

Increased risk for falls, related to conditions such as weakness, disability, or unsteady
gait

There may be other risks, depending on your specific medical condition. Be sure to
discuss any concerns with your healthcare provider.

What are the symptoms of a hip fracture?

The following are the most common symptoms of a hip fracture. However, you may experience
symptoms differently. Symptoms may include:

Hip pain and/or pain that you can feel in your knee

Low back pain

Inability to stand or walk

Bruising and swelling

Foot turned out at an odd angle, making your leg look shorter

The symptoms of hip fracture may resemble other medical conditions. Always talk with
your healthcare provider for a diagnosis.

How is a hip fracture diagnosed?

In addition to a complete medical history and physical exam, diagnostic procedures
for hip fracture may include the following:

Magnetic resonance imaging (MRI). A combination of large magnets, radiofrequencies, and a computer produce detailed
images of organs and structures within your body.

Computed tomography scan (also called a CT or CAT scan). This is an imaging test that uses X-rays and a computer to make detailed images of
the body. A CT scan shows details of the bones, muscles, fat, and organs. CT scans
are more detailed than standard X-rays.

A fracture of your hip is generally treated with surgery. Your surgeon may use metal
devices to strengthen and stabilize your joint. In some situations, he or she may
do a partial or total hip replacement. The type of surgical repair will depend on
the type of hip fracture. Your surgeon will determine the best procedure for you,
based on your individual situation. The goal of treatment is to provide relief from
pain and enable you to resume your normal activity level. Hip surgery usually requires
an in-hospital stay. While in the hospital, you begin doing physical therapy exercises
to regain strength and range of motion in your hip. Physical therapy will continue
at home or on admission to a rehabilitation facility.

What are the complications of hip fracture?

Serious complications can result from a hip fracture. Blood clots can happen in the
veins, usually in your legs. If a clot breaks off, it can travel to a blood vessel
in your lung. This blockage, called a pulmonary embolism, can be fatal.

Other complications can include:

Pneumonia

Muscle atrophy (wasting of muscle tissue)

Postoperative infection

Nonunion or improper union of your bone

Mental deterioration following surgery in older patients

Bedsores from lying in the same position with minimal movement

With some fractures, blood cannot circulate properly to the head of the thigh bone.
This results in a loss of blood supply to this area. This is called femoral vascular
necrosis, or avascular necrosis. This complication may happen, depending on the type
of fracture and the anatomy of your blood supply to the head of the thigh bone. This
is more common with femoral neck fractures.

Most people spend from 1 to 2 weeks in the hospital after a hip fracture. The recovery
period may be lengthy, and may include admission to a rehabilitation facility. If
you were previously able to live independently, you will generally need help from
home caregivers or family, or need the services of a long-term care facility. Hip
fractures can result in a loss of independence, reduced quality of life, and depression.
This is especially true for older people.

Can a hip fracture be prevented?

Preventive measures include taking enough calcium every day.

If you are a woman at menopause, you should consider having a bone density test. This
measures your bone mineral content and the thickness of your bone. This measurement
can indicate decreased bone mass. This is a condition in which your bones are more
brittle and more prone to break or fracture easily. A bone density test is used primarily
to diagnose osteoporosis and to determine fracture risk.

Women, who sustain the majority of hip fractures, make less estrogen when menopause
begins. Most people do not know they have osteoporosis until they sustain a fracture.

Another way to help prevent hip fracture is to engage in regular weight-bearing exercise,
such as walking, jogging, or hiking. Exercise programs such as Tai Chi help promote
strength and balance.

Keeping objects off the stairs and floors, such as electrical cords, to prevent falls

Using slip-resistant rugs next to the bathtub, and installing grab bars in the tub

Positioning night lights from the bedroom to the bathroom

Using rug pads or nonskid backing to keep rugs in place

Not using unsteady furniture or step ladders to stand on

Visiting an ophthalmologist every year to have vision checked annually and vision
loss treated

Key points about hip fracture

The majority of hip fractures happen to people older than age 60. The incidence of
hip fractures increases with age, doubling for each decade after age 50. Hip fracture
is a serious injury and needs immediate medical attention.

A fall is the most common reason for a hip fracture among the elderly.

Hip fracture is more common among women.

Osteoporosis and advancing age are the major risk factors.

A fracture of the hip is generally treated with surgery.

Serious complications can result from a hip fracture.

Preventing a hip fracture is more desirable than treating one.

Women at menopause should consider having a bone density test.

Regular weight-bearing exercise helps to prevent a hip fracture.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.

Before your visit, write down questions you want answered.

Bring someone with you to help you ask questions and remember what your provider tells
you.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.

Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.

Ask if your condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if you do not take the medicine or have the test or procedure.

If you have a follow-up appointment, write down the date, time, and purpose for that
visit.